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1790241594 NPI number — STEPHANIE HOLTON HENDRICK FNP-C

NPI Number: 1790241594
Health Care Provider/Practitioner: STEPHANIE HOLTON HENDRICK FNP-C

Information about “1790241594” NPI (STEPHANIE HOLTON HENDRICK FNP-C) exists in 1790241594 in HTML format HTML  |  1790241594 in plain Text format TXT  |  1790241594 in PDF (Portable Document Format) PDF  |  1790241594 in an XML format XML  formats.

NPI Number : 1790241594 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790241594",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENDRICK",
    "FirstName": "STEPHANIE",
    "MiddleName": "HOLTON",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "FNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2001B LEIGHTON DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27834-4854",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "252-394-7555",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "108 KNELLS RIDGE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESAPEAKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23320-4885",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-436-1234",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/17/2019",
    "LastUpdateDate": "02/21/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "0024177308",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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